SP3.1.8 What happens to patients with acutely symptomatic hernia in the UK? Findings from the MASH study

Abstract

Aims: Acutely symptomatic abdominal wall and groin hernias (ASH) are a common reason for acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high risk patients. Methods: A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on investigations, specific surgical intervention, in-hospital morbidity and mortality, and quality of life was measured. 30 and 90-day follow-up phone calls collected complications and quality of life. Descriptive analyses were performed to describe population and outcomes. Results: Twenty-three acute Trusts recruited 264 patients. Inguinal (37.9%) and umbilical (37.1%) were the most common hernia locations. 17% were awaiting elective surgery and 17% had been previously declined intervention. CT was performed in 47%. 82% of patients had surgery within 48 hours, with 95% of procedures performed open and 93% under general anaesthesia. 3/11 laparoscopic procedures were converted to open. Mesh was used in 55%, this was typically synthetic non-absorbable (86%). Complications were infrequent; 2% developed pneumonia or delirium. Surgical site infection occurred in 3% and mortality was 1.2%. Quality of life improved between baseline and 30-days following repair. Conclusions: There is variation in the management of ASH in the UK, particularly with repair techniques, use of mesh and laparoscopy. One in five patients was awaiting repair; this might indicate a need for expedited pathways and reprioritising of elective hernia repair.